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HomeMy WebLinkAbout04-0011PETITION FOR PROBATE and GRANT OF LETTERS Estate of also known as CLARENCE E. BLUMBERG Deceased Social Security No 174-05-3746 No Register of Walls for the County of Cumberland m the Commonwealth of Pennsylvania The petltxon of the undersigned respectfully represents that Your petitioner is 18 years of age or older and the Executrix named in the last will of the above decedent, dated December 20, 1985 and codlcd(s) dated none Decedent was dom,~cded at death m Cumberland County, Pennsylvania, w~th h~s last famdy or pnnmpal residence at 129 West ~outh Street, Carlisle Borough. Decedent, then 89 years of age, died December 24, 2003, at Carlisle Regional Medical Center, Carlisle, Pennsylvania Except as follows, decedent d~d not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate, was not the victim of a kdbng and was never adjudicated ~ncompetent Decedent at death owned property with estimated values as follows (If dom~cded in Pa ) All personal property (If not dommded in Pa ) Personal property in Pennsylvama (If not dommfled in Pa ) Personal property ~n County Value of real estate ~n Pennsylvama s~tuated as follows Carhsle Borough, Cumberland County $ unest~mated $ $ unestlmated WHEREFORE, petitioner respectfully requests the probate of the last will and codlcd(s) presented herewith and the grant of letters testamentary thereon ,fi/f~vonne B Welch n/k/a Vvo~e F Karper '' / b'322 West South Street ~' Carlisle, PA 17013 (717) 243-6847 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petitioner above-named swears or affirms that the statements in the foregmng petition are tree and correct to the best of the -knowledge and behef of petitioner and that as personal representatwe of the above decedent, petitioner will well and truly administer the estate according to law Sworn to or affirmed and subscribed '~,,~.~)E~_/~/.~ 2'fn.*-t-o~t.T'f, .'='"'-' ,~,~c~ /]~,~f~er~nthu,~_ 5t~h ,?0da0Yaof /fi/~vonne B Welchn/k~aYxo~fieF Karper No. 21-2004-0011 Estate of Clarence E. Blumberg, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, January 5th, 2004 , in consi ,deration of the petition on the reverse side hereof, sattsfactory proof hav,ng been presented before me, IT IS DECREED that the instrument(s) dated December 20, 1985 described therein be admitted to probate and filed of record as the last will of Clarence E Blumberg and Letters Testamentary are hereby granted to Yvonne B Welch n/Ida Yvonne F Karper Page Glenda Farner Strasbau~th FEES Probate, Letters, Etc $ 235.00 Short Cemficates(2 ) $ 6.00 ~ x-Pages (1) $ 3.00 JCP fee $ 10.00 TOTAL $ 254.00 Edward I: Schorpp (17495) ~TTORNEY (Sup Ct I D No ) MARTSON DEARDORFF WILLIAMS & OTTO 10 East H~gh Street Carhsle, PA 17013 (717) 243-3341 Filed January 5th, 2004 Call Attorney on 1/5/04 his is to certify that the information here g~ven Is correctly copied from an original certificate of death duly filed w~th~ me as Local Registrar The original ceruficate wdl be forwarded to the State Vital Records Oflqce for permanent filing WARNING: It ~s illegal to duplicate this copy by photostat or photograph. Fee for th~s cemficate, $2 00 P 9898999 No 2003 COMMONWEALTH OF PENNSYI.VANIA * OEPARTMENT OF HEALTH * VITAl. RECORDS CERTIFICATE OF DEATH Clarence E. M ~ 174 -- 05 -- 3746 89 Ct~nberland Carlssle Bore. ~Carl~sle Regsonal Medical Center ~Y~onne F. garper m322 . College Street, ~arC~s]o, PA 17013 ~f~ ~ I,,b FD 012633 L ~nc~lnq Brothers Funeral H~, Inc., ~rl~]o, PA LAW OI ['ICES LANDIS, BLACK, JOHNSON & SCHORPP CARLISLE. PENNSYLVANIA 1701 ~ LAST WILL AND TESTAMENT OF CLARENCE E. BLU~BERG I, CLARENCE E. BLU~BERG, a legal resident of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this'asand for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by FIRST: I direct that ali my just debts and funeral expenses, includ- Lng my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I devise and bequeath the residue of my estate, of every nature and wherever situate, to my daughter, Yvonne B. Welch, provzded that should she predecease me or die on or before the thirtieth day following my death her share shall be distributed to her issue, per stirpes, living on the th~rty-f~rst day following my death. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint my daughter, Yvonne B. Welch, Executrix of this, my Last Will and Testament. In the event of the re- nunciation, death, resignation or inability to act for any reason whatsoever of the said Yvonne B. Welch, I nominate, constitute and appoint Farmers Trust Company, of Carlisle, Pennsylvania, Executor of this, my Last Will and Testa- ment. I hereby relieve my Executrix or her successor from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to tHis,my Lasl Will and Testament, this~day of ~~, 19~. E. Blumbe~ S~gned, sealed, published and declared by the above-named Testator, Clarence E. Blumberg, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and pre- sence of each other have hereunto subscribed our names as witness~. LANDIS, BLACK, JOHNSON & SCHORPP ACRNOWLED(~IENT ODb~TH OF PENNSYLVANIA ) : SS. COUNTY OF OlqBERLAND ) I, CLARENCE E. BLUMBERG , Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affimed to and ac]~nowledgod before me by CIARENCE E. BLUMBERG, the Testator, this ~ day of~ , 1985. i// 'Cl~ar~.e. ~l~mberg My Commm:,on Exptre~ Sept. 19, 1987 ~FIDA~T COlq~3NI~rgLTH OF PE~qSYLVANIA ) : SS. COUNTf OF CO~ERLAND ) whose names are signed to the attached or foregoing~instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that CLARENCE E. BLUHBERG signed willingly and that he executed it as his free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue in~uence. ~ Swgr~ _~or/~tf~irmed and ~ i'~ to and subscribed to b~fore me by/g EDWARD. L. SCHORPP , witnesses, this ~day of ~ 1985. Carh.le, Cu,nbcr!an. Co, Fa F/FILES\DATAFILE/ESTATESk1107 I-I notice ¢cr Name of Decedent Date of Death File No To the Register CERTiFICATION OF NOTICE UNDER RULE 5 6(a) Clarence E Blumberg December 24, 2003 21-04-0011 I certify that notice of estate administration required by Rule 5 6(a) of the Orphans' Court Rules was served on or mailed to the follow~ng benefimanes of the above-captioned estate on or about March 19, 2004 Mrs Yvonne F Karper 322 North College Street Carhsle, PA 17013 Notice has now been given to all persons enmled thereto under Rule 5 6(a) except N/A Date March 19, 2004 Signature Name MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carhsle, PA 17013 (717) 243-334I Attorneys for Personal Representative ~0Mi~IONWEALTH OF PENNSYLVANIA _~pART,MENT OF REVENUE BUR. ~ ~., OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 0O3696 SCHORPP EDWARD L 10 EAST HIGH STREET CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 174-05-3746 FILE NUMBER: 2104-001 1 DECEDENT NAME: BLUMBERG CLARENCE E DATE OF PAYMENT: 03/1 8/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/24/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $9,000.00 R~EMARKS' CHECK//1005 SEAL TOTAL AMOUNT PAID: 99,000.00 INITIALS' JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Name of Decedent. Date of Death File No To the Register CERTIFICATION OF NOTICE UNDER RULE 5 6(a) Clarence E Blumberg December 24, 2003 21-04-0011 I certify that notice of estate administration required by Rule 5 6(a) of the Orphans' Court Rules was served on or mmled to the following beneficiaries of the above-captioned estate on or about March 19, 2004 Mrs Yvonne F Karper 322 North College Street Carlisle, PA 17013 Not~ce has now been given to all persons entitled thereto under Rule 5 6(a) except N/A Date March 19, 2004 Signature Name MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 24%3341 Attorneys for Personal Representative REV - I SOg EX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I OFFICIAL USE ONLY FILE NUMBER 21 04 0001 l COUNTY CODE YEAR NUMBER n,,z Oo Z DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) BLUMBERG, CLARENCE E. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 12/24/2003 04/09/1914 IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 174-05-3746 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) ] 4. Limited Estate [] 4a. Future Interest Compromise (da e of death after 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between ~IAME Edward L. Schorpp, Esquire 12-31-91 and 1-1-95) --IRM NAME (If applicable) Martson Deardorff Williams & Otto tELEPHONE NUMBER 717/243-3341 [] 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS Ten East High Street Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 51,000.00 None None None 1,984.03 118,219.83 69,840.35 26,485.83 4,015.23 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) ©~F!CIAL [JS~ (8) 241,044.21 (11) 30,501.06 (12) 210,543.15 (13) (14) 210,543.15 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) x .00 (15) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 210,543.15 x .045 x .12 x .15 (16) 9,474.44 (17) (18) (19) 9,474.44 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: ISTREET ADDRESS 129 West South Street CITY Carlisle STATE PA z~P 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 9,000.00 473.68 9,474.44 Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) Total InterestJPenalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 9,473.68 0.00 0.76 0.76 (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .................................................................................. ~ ~ b. retain the right to designate who shall use the property transferred or its income; .................................... c. retain a reversionary interest; or .................................................................................................................. d. receive the promise for life of either payments, benefits or care? .............................................................. [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. preparer other than the personal representative is based on all information of which preparer has any knowledge, SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Yvopne F. Karper ATURE OF PERSON RESISON~IBLE ~:)R FILING RETURN ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS 322 North College Street Carlisle, PA 170'13 DATE DATE Edward L~Schorp. i~ Esj]~ll'O /~/? ..~ DATE · ..~--~'~ ~,.,'~ ~/', ~//'./~/~.,~'~(.~ Ten East High Street . / , ~~~~~. ......... ~ .....Carl_!.sle, PA 17013 /~/~/~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survivin9 spouse is 3% [72 P.S. §9118 (a) (1.1) (i)]. For dates of death on or after January 1, ~ 995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9'116 (a) {1.'1) (ii)]. lhe statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COIMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BLUMBERG, CLARENCE E. SCHEDULE A REAL ESTATE FILE NUMBER 21 - 04 - 00011 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a w ng buyer and a willing seller, neither being compelled to buy or sell, both havin [~lSeO~ualbel~=.knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosedgon ITEM ] DESCRIPTION Residence situate at 129 West South Street, Carlisle Borough, Cumberland County, PA, known as parcel No. 04-21-0320-273, being described in Deed dated May 11, 1988 and recorded in Cumberland County, PA, Deed Book 'T', Volume 33, Page 413, and being conveyed to Clarence E. Blumberg. Value is actual sale price. TOTAL (Also enter on Line 1, Recapitulation) VALUE A-r DATE OF DEATH 51,000.00 51,000.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF BLUMBERG, CLARENCE E. FILE NUMBER 21 - 04 - 00011 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 2 3 4 5 6 DESCRIPTION Waypoint Bank checking account # 90115494 Highmark, refund of premium Comcast, refund Proceeds of sale of household contents Real estate tax proration Sprint, refund TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 213.45 120.84 9.51 1,278.88 360.17 1.18 1,984.03 COMMONWEALTH OF PENNSYLVANIA IINHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF BLUMBERG, CLARENCE E. 'FILE NUMBER 21 - 04 - 00011 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Yvonne F. Karper 322 North College Street Daughter Carlisle, PA 17013 JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY ITEM LETTER DATE Include name of financial institution and bank account number % OF DATE OF DEATH DATE OF DEATH DECD'S VALUE OF NUMBER FORTENANTJOINT JOINTMADE estate.er similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTERES'I 1 A 02/23/2002~ Waypoint checking account 52.89 509 26.45 #1703024248 2 A 02/23/2002 Waypoint Bank CD #1700015369 215,948.39 50% 107,974.20 3 A 01/18/2002 Waypoint Bank CD #7100021885 14,563.98 50% 7,281.99 4 A 02/25/1999 Waypoint Bank CD #8000046522 4,440.27 50~ 2,220.14 5 A 03/27/1995 Waypoint Bank CD #8000013577 1,434.09 50~ 717.05 TOTAL (Also enter on line 6, Recapitulation) 118,219.83 COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RI::::SIDE NT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF BLUMBERG, CLARENCE E. FILE NUMBER 21 - 04 - 00011 This schedule must be completed and filed if the answer to any of questions 1 thro~ 4 on page 2 ' DESCRIPTION OF PROPERTY ITEM Include the name of the transferee, their relationship to decedent and the date of transfer. DATE OF DEATH % OF NUMBER Atlach a copy of the deed for real estate. VALUE OF ASSET DECD'S EXCLUSION TAXABLE VALUE (IF APPLICABLE INTEREST 1 AGI Annuity BX205020, beneficiary: Yvonne F. Karper, 14,457.15 100% 14,457.15 daughter 2 John Hancock Annuity GP07215135, beneficiary: Yvonne 55,383.2¢ 100% 55,383.20 F. Karper, daughter IOIAL (Also enter on line 7, Recapitulation) 69,840.35 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF BLUMBERG, CLARENCE E. FILE NUMBER 21 - 04 - 00011 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT Ao Bo FUNERAL EXPENSES: Ewing Brothers Funeral Home, Carlisle, PA ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Martson DeardorffWilliams & Otto (estimated) Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Certified mailing, Department of Public Welfare Cumberland Law Journal, advertising letters testamentary Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 7,779.00 14,500.00 254.00 4.42 75.00 3,873.41 26,485.83 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BLUMBERG, CLARENCE E. Schedule H Funeral~& .N~min~ Costs continued FILE NUMBER 21 04-000]] 4 5 6 7 8 9 10 11 12 13 14 15 16 17 The Sentinel, advertising letters testamentary Register of Wills, filing fee, Inheritance Tax return Cumberland County Recorder of Deeds, copies Waypoint Bank, checkbook PPL Electric Utilities, electric service pending disposition of real estate UGI, gas service pending disposition of real estate Borough of Carlisle, water/sewer service pending disposition of real estate Peerless, homeowner's insurance Diversified Appraisal Service, real estate appraisal fee Dehart's Auction Service, commission on sale of real estate Dehart's Auction Service, advertising 1% Realty Transfer Tax Darlene Moyer, Tax Collector, 2003 real estate taxes Overnight mail charge, settlement documents Reserved for additional filing fees and miscellaneous maintenance expenses 122.63 15.00 2.50 3.00 85.48 158.00 69.00 288.90 275.00 1,530.00 158.00 510.00 399.60 6.30 250.00 Page 2 of Schedule H COIMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF BLUMBERG, CLARENCE E. FILE NUMBER 21 - 04- 00011 Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 DESCRIPTION Outstanding checks on date of death, Waypoint checking account #90115494 Peerless Insurance, account payable PA Department of Revenue, estimated penalty on 2002 taxes PPL Electric Utilities, account payable UGI, account payable Church of God Home, account payable Borough of Carlisle, account payable Sprint, account payable Central Penn Group Emergency, account payable PA Dept. of Revenue, 2003 individual income tax U.S. Treasury, 2003 individual income tax TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 119.38 55.10 15.48 24.79 84.00 2,310.00 15.08 37.51 29.89 448.00 876.00 4,015.23 REV-1513 ~..X+ (9-00) ~ SCHEDULE J COMMO~LTH OF PENNS~LVAN,A BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BLUMBERG, CLARENCE E. FILE NUMBER 21 04 00~ RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT Do Not kl.t mru~fAels} OF ESTATE 1. TAXABLE DISTRIBUTIONS (include outright spousal distributions) I Yvonne F. Karper Daughter Entire residue 322 North College Street Carlisle, PA 17013 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DI$iHIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ^. Settlement Statement B, Ty~a o[ Loan U.$. Department of Housing and Urban Devdopmoot O1t~No. 2502-0265 1./mJpI-IA 2,[~]FtnHA 3, ~]Conv. UnJn$. .6, FHa ~ 7. Lonn um~r 8. Mott~g~ ns, C~u~ber C. Thi~ fo~ i~ ~mish~ ~ ~ st~mm~nt o~ ~cmM ~nt cos~. A~un~ paid m ~d b~ ~e ~mcnt agen~ ~e ~ho~. I~ marked D. N~e and AddreSs of ~rrowet B. Na~c and Address of 8citer / F, Na~ and A~drcas at' ~der Montarey gv~p L~ Yvonnc F. Ker~v C~H P.D. Box 476 Ex~utr~x under Las~ ~ & Testament Enole, PA of Clarence E, Blumber~ lgg West South St~t Carl i~le, Pennsyl yani a ylace et ~me~nt Cm~rl and County~ 2157 Harket Street : Camp Htll PA 17011 05/13/2004 · 51,000,00 102. Per~rn~l pmporty .. ~~ 402. eorsonal proper~ ~ ~S ~o borro~erOJne 1400) ~ ~3. 104. 404. Adju~en~ for item~ paid by ~Ii~ in advance Adjus~n~ ~Or i~ ~y miler in ~vsnco '"]~. County taxes 05/13/2~ 2~.9~ ~. Coun~ ~xes 05/13/20~ 12/31/2004 2~.99 108. A~nM 05/13/~/2004 115,~ 408, Assessm=nm 05/13/200& 06/30/2004 115,18 log. 40J, '"'l'll, " 410. ... '~iL "" 20], Deposit or emn~st ~ney 5.10O. 00 501. ~eaS d~os{~ lns~ctiom) 5,100. 202, ~ine~p~ a~ount of n~ {o~(s) ........ ~02, Se~e~nt chatg~ 204. ~5. , ..... 5~. ~yoff of first mortg~e loan 206. , ...... ~0~, Payo~ of ~nd ~gage ~oan 506. ~./. ' ...... 208 ...... 209 ......... 509. ' ' ' ' ....... Adju~nU~ rot ileum unp~i'd by ~llcr AdjustmenLm for I~ems unpaid by s~llJ ..... 210. Ci~/tn~ m~* ~ ....... 510. di~)~wn ~es to ll 1. Coun~ t~es 211. A~ess~nm to 5 i~, ~s~s~nts to 213. 214. 513, 2~. 217. ' .... 218. 30J. Gross ~unt ~ from botrower(l~o 120) ~, S~Y. 67 601. Oross amount du~ 3OZ' ~aS a~nt paid by/for 0orrower0/ne 2:0) fi. 2OO. OO) 602. Less reduction ~ount due~~ Tho information contained in Blocka E, O. I--I and 1 and on llne 401 or. if tine -40 is asterisked. inca 403 and 404 is important tax lnforTnatinn and ia b~ing t~ornished to the Interned ReVenue Scrvicc, If you are required to file a return, ~t ne~,li.qence ~ena)ty or other sanction will bu imposed on you if Ufis item is required tx~ be reported nnd th~ ]Y,~ determines that it has not been reported, iUD- 1 SETTLEMENT STAT]:~VlI~NT Brainstorm Software 1-540-66_q-0800 W~,R. NINc: It iea c~;ra..e to knowingly ~ake t~la~ a at~m~nL~ ~ on th~, 0r any other 81~dlr form. Pen~bes upas convlcdon Can ~c Unkea include an~ ~mprJ~o~nt. FOr 4~i[s ~e~: TMc 18 U.& ~od~ Section 1001 ~ 1010, SETTLEHENT STATE~NT PAOE 2 (line 700) ss follows: to ~o pald a: Settlerr~nt PUNDS AT FUNDS AT gET/PL~MENT $~TTLBMENT 80'7. 808. 809. ~lO, $11. OdginaUon )rtgagc ]'n~urahc· to to to 901. 905. [~qon ths to year~ to /day I001. 1003. City property r, axes 1006. 1007. [008. .l'100, 110l, Se~ement ot clo$i~g f~ to 1 ]02. Abstract ot 110:3. Titlc oxnmlnatlon"--'~'~'-" to ~tion to ] 106..Notary fee~ per month mantks @ $ monms ~ $ . _ per month months. ~ $ per month montha ~ $ 33.30 mon~s ~ $ per month Law O~ DaY .a~za to cash 1107. AEorney'~ ~ea . to (includeeabov~]tertW. Numbero; 1108.~ to (includes above itentm Numbers: 1201. Recording feet: : Deed $ 38 50 . .. 1301. Survey to 1302. PestJnspectJon to 1305. Law ~ ;Releaae,~ $ 10.00 38.50 510.00 15.08 I have csrcfui y reviewed the HUD ge ............ CERTIFICATION ~ucm~n~ ~,tat~men! ann to the bes~ of tn · . uorrowers P.O~' Box 476 ~ell~ -- . Th~ ~UD-I $ettl=m~nt 8~tcme~t whi~ I ye prepared S, . . Executetx ~dee '~ast ~ & Testment In accoraance Witll rills SI~ . ~~ a tr~c ~d nccura~ account of tb~$ tt~s8cho~, ] have ~a~scd or w/Il cause the ~nds to be disbursed ~~"t O~v~a O. Lanz~m~ ~ay 13~ 2004 LOOK FOR US. WE'LL GET YOU THERE. 1/9/2004 MDW&O TEN EAST HIGH ST CARLISLE PA 17013 The information which you requested on the account(s) of CLARENCE E BLUMBERG (Social Security Number 174-05-3746) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established 1700015369 1703024248 7100021885 8000013577 8000046522 CERTIFICATE CHECKING CERTIFICATE CERTIFICATE CERTIFICATE 022300 022300 011802 032795 022599 215000.00 52.89 14520.52 1430.00 4426.91 948.39 0.00 43.46 4.09 13.36 215948.39 52.89 14563.98 1434.09 4440.27 90115494 CHECKING 090382 213.45 0.00 213.45 Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established JTO JTO JTO JTO JTO SOLE YVONNE F YVONNE F YVONNE F YVONNE F YVONNE F KARPER KARPER KARPER KARPER KARPER 022300 022300 011802 032795 022599 090382 Additional Information Requested SENIOR SERVICES REP. P.O. Box 171 I. HARRISBUR6, PENNSYLVANIA 17105-1711 Toll Fr~E ~-8(~6-WAYPOINT (14366-D;=9-7646) · IN YORK AREA 717/815-4500 · vvvvw, wa~lpointbank.com LAST WILL AND TESTAMENT OF CLARENCE E. BLUMBERG CORPORATION ?G~-] 3TREET I, CLARENCE E. BLUMBERG, a legal resident of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this ss and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by IRe. FIRST: I direct that all my just debts and funeral expenses, includ- zng my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I devise and bequeath the residue of my estate, of every nature and wherever situate, to my daughter, Yvonne B. Welch, provided that should she predecease me or die on or before the thirtieth day following my death her share shall be distributed to her issue, per stirpes, living on the thirty-first day following my death. THIRD: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. FOURTH: I nominate, constitute and appoint my daughter, Yvonne B. Welch, Executrix of this, my Last Will and Testament. In the event of the re- nunciation, death, resignation or inability to act for any reason whatsoever of the said Yvonne B. Welch, I nominate, constitute and appoint Farmers Trust Company, of Carlisle, Pennsylvania, Executor of this, my Last Will and Testa- ment. I hereby relieve my Executrix or her successor from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this,my Last Will and Testament, this ~----~-~aday of ~~~~ , 198~. -~--~---~- ~-~ ~ '.~B'~mb er~ (SEAL) Clarence sence of each other have hereunto subscribed our names as witnesse~. L~NDIS, BLACK, . ! Signed, sealed, published and declared by the above-named Testator, Clarence E. Blumberg, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and pre- LAW OFFICES LANDIS, BLACK, JOHNSON ~- SCHORPP CARLISLE. PENNSYLVANIA 1701' ACKNOWLEDGMENT COb~CDNWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) SS. I, CLARENCE E. BLUMBERG , Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and aclcnowledge~ before me by CLARENCE E. BLUMBERG, the Testator, this ~.~. r~- day of /~-.Y_.C)zm?~.-~J .... , I985. Tes~,~or - ?7 Cla~e ~berg .'/ q . L ,., " ' Notary .P~blic ..... ' .... :,.. ~. ~.:.. ; // , / ~..::: . . · :.:.. ~ ~e~r. 19, COIvIVlONWEALTH OF PENNSYLVANIA ) : SS. COUNT~ OF C~.~ERLAND ) /? ..,? ,.'/ We, EDWARD L. SCHORPP and ~/~,./~::.L::L_ (, ./(/-.~L>~::F~.~ the witne_sses whose names are signed to the attached or foregoing-instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that CLARENCE E. BLUMBERG signed willingly and that he executed it as his free and voluntary! act for the purpose therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind a=nd under no constraint or undue ~.f!uence. :7 Swo..rg.or/if~irmed to and subscribed to before me by/), EDWARD~ L. SCHORPP ~otary ~lic ' 1N RE: ESTATE OF CLARENCE E. BLUMBERG, DECEASED : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : : ORPHANS' COURT DIVISION : NO. 2004-0011 FIRST AND FINAL ACCOUNT OF YVONNE F. KARPER, EXECUTRIX OF THE ESTATE OF CLARENCE E. BLUMBERG, LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA Date of Death: Letters Testamentary Granted: Letters Advertised: The Sentinel - Cumberland Law Journal - Account Stated as Final December 24, 2003 January 5, 2004 January 9, 16, 23, 2004 January 16, 23, 30, 2004 [The account also indicates the proposed distribution of the estate.1 PRINCIPAL Receipts Less Disbursements Balance Before Distributions Distributions to Beneficiaries Principal Balance Remaining SUMMARY $ 53,225.03 -28,481.24 24,743.79 -17,393.88 $ 7,349.91 INCOME Receipts Less Disbursements Income Balance Remaining COMBINED BALANCE REMAINING 5.54 0.00 5.54 7,355.45 PRINCIPAL RECEIPTS Real estate at 129 West South Street, Carlisle Waypoint checking #90115494 Highmark, refund of premium Comcast, refund Proceeds of sale of household goods Real estate tax proration Sprint, refund Peerless Insurance, refund of premium TOTAL PRINCIPAL DISBURSEMENTS various 01/19/04 various various various 01/21/04 01/27/04 02/02/04 02/02/04 02/02/04 02/17/04 03/18/04 03/25/04 Outstanding checks on date of death Waypoint checking account #90115494 Peerless Insurance, homeowner's PPL, electric service UGI, gas service Carlisle Borough, sewer/water service Waypoint, checkbook fee PA Dept. of Revenue, estimated penalty on 2002 taxes Ewing Brothers Funeral Home Chumh of God Home Sprint, telephone service Peerless Insurance Company, homeowner's Register of Wills, Agent, inheritance tax Diversified Appraisal Service, real estate appraisal 51,000.00 213.45 120.84 9.51 1,278.88 369.17 1.18 232.00 53,225.03 119.38 55.10 110.27 242.00 84.08 3.00 15.48 7,679.00 2,310.00 37.51 288.90 9,000.00 275.00 -2- 04/06/04 04/08/04 04/08/04 04/20/04 04/27/04 05/13/04 05/13/04 05/17/04 06/02/04 06/02/04 Reserved Reserved TOTAL Central Penn Medical Group Emergency PA Dept. of Revenue, 2003 income tax U.S. Treasury, 2003 income tax Dehart's Auction Service, advertising Darlene Moyer, real estate taxes Carlisle Borough, sewer/water County of Cumberland, 1% realty transfer tax Dehart's Auction Service, commission on real estate Martson Deardorff Williams & Otto, interim attorney fees Martson Deardorff Williams & Otto, disbursements: Recorder of Deeds, copies Probate fee Cumberland Law Journal, advertisement The Sentinel, advertisement Postage, certified delivery UPS, package delivery Martson Deardorff Williams & Otto, balance, attorney fees Martson Deardorff Williams & Otto, disbursements for filing fees, miscellaneous costs and expenses 2.50 254.00 75.00 122.63 4.42 6.40 DISTRIBUTIONS TO BENEFICIARIES 06/02/04 Yvonne F. Karper, Cash TOTAL INCOME RECEIPTS Waypoint checking #90115494, interest through closing Waypoint C.D. interest TOTAL 29.89 448.00 876.00 158.00 399.60 15.08 510.00 1,530.00 2,230.00 464.95 1,200.00 400.00 $ 28,481.24 $ 17,393.88 $ 17,393.88 $ 0.01 5.53 $ 5.54 -3- INCOME DISBURSEMENTS None TOTAL $ $ 0.00 0.00 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND f~onne F. Karper, E~e"utrix ) ) Yvonne F. Karper, being duly sworn according to law, deposes and says: That she is the Executrix of the Estate of Clarence E. Blumberg, deceased; that she has fully and faithfully discharged the duties of her office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that to her knowledge, there are no claims now outstanding against the Estate; that all taxes presently due from the estate have been paid; and that the Grant of Letters Testamentary and the first complete advertisement thereof occurred more than four (4) months before the filing of the Account. Sworn and subscribed to before me this ~/~T dayof ~ e F. Karper, Executj~ Not"~y Public ~ NOTARIAL SEAL CORRINE L. MYERS, NOTARY PUBLIC CARLISLE BORO, COUNTY OF CUMBERLAND MY COMMISSION EXPIRES MAY 27, 2007 -4- SCHEDULE OF PROPOSED DISTRIBUTION Yvorme F. Karper, Executrix of the Last Will and Testament of Clarence E. Blumberg, deceased, proposes to distribute the balance in her hands, to wit: $7,355.45, in accordance with the said Last Will and Testament as heretofore filed in the Office of the Register of Wills of Cumberland County, Pennsylvania, as follows: TO: Yvonne F. Karper, per Item Second of said Will: Cash: $ 7,355.45 STATEMENT OF THE REASONS FOR THE PROPOSED DISTRIBUTION The above distribution is proposed in accordance with the Last Will and Testament of Clarence E. Blumberg. Sworn and su.b~s~ribed to before me thisc:~/67- dayof ~x.~ Notary Public NOTARIAL SEAL CORRINE L. MYERS, NOTARY PUBLIC CARLISLE BORO, COUNTY OF CUMBERLAND MY COMMISSION EXPIRES MAY 27, 2007 onne F. Karperl l~oe/utrix -5- LAN-DIS, BLACK: JOHNSON & SCHORPP LAST WILL AND TESTAMENT OF CLAR~CE E. BLUMBERG I, CLARENCE E. BLUb~HRG, a legal resident of the Borough of Carlisle, Cumberland County, Penp. sylvpnia, ~?~ of sound and disposing mind, memory and understanding, do hereby make, pUDZZ- and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by FIRST: I direct that all my just debts and funeral expenses, includ- ing my gTave marker, shall be paid from the assets of my estate as soon as practicable after my decease. SECOND: I devise and bequeath the residue of my estate, of every nature and wherever situate, to mM. daughter, Yvonne B. Welch, provided that ;hould she predecease me or die on or before the thirtieth day following my teath her share shall be distributed to her issue, per stirpes, living on the thirty-first day following my death. THIRD: I direct that all taxes that ma~ b? aCse~sed.in consequence ..... ~ -.~+ .... nature and by whatever 3ur~sd~ct~o~ zm~,o~e~,_sh~l be oz my oeacn, uz wu~* - ~ ~ ..... n~ ~f the aomlnlSsraLlon paid'from my residuary estate as a parz oz ~nu ¢xp¢ ..... of my estate. FOURTH: I nominate, constitute and appoint my daughter, Yvonne B. Welch, Executrix of this, my Last Will and Testament. In the event of the re- nunciation, death, resignation or inability to act for any reason whatsoever of the said Y¥onne B. Welch, I nominate, constitute and appoint Farmers Trust Company, of Carlisle, Pennsylvania, Executor of this, my Last Will and Testa- ment. I hereby relieve my Executrix or her successor from the necessity of posting security in connection with their duties as such in any jurigdiction in which they may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Las1 Will and Testament, this~~'day of .~,~~~-~ , 19~. Signed, sealed, published and declared by the above-named Testator, Clarence E. Blumberg, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and pre- sence of each other have hereunto subscribed o~r names as w, itness~%; LANDIS, BLACK, ACKNOWLEDGMENT. C0b~ONWEALTH OF PENNSYLVJdqlA ) : COUNTY OF CUMBERLAND ) SS. I, CLARENCE E. BLUMBERG , Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as tm/ free and voluntary act for the purposes therein expressed. Sworn or affirme>d to and ac%knowledged before me by CLARENCE E. BLUMBERG, the Testator, this :.~~ day of /~g'.~;~,>~,fS~ , 1985. ' Notary ,~lic AFFIDAVIT CONlqONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF Cm.mERLAND ,t..) . .. ( / ,: ., . We, EDWARD L. SCHORPP ana;l~t:z/.g;:x¢:.~ -. ~ ..... ,., . whose names are signed to the attached or foregoing~'~nstrument, bemng duly qualified according to law, do depose and say that we were present and Testator sign and execute the instrument as his Last Will; that CLARENCE BLUMBERG signed willingly and that he executed it as his free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testator signed the Will as ~tnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind mhd under no constraint or ,mnd~ ~nfluen~. j Swo~ or/Affirmed to and subscribed to before me b,~-) EDWARD., L. SCHORPP .- /~. ~ ' ~ ':' ~'-/~ of ,/,:.,~:,.~¢~;.;~.d.-C~..., 1985. .,-.,~ ,,/~z.,.-z,:~_ ~.:~.:~,',::_.:vr. , witnesses, this >~_~... day · Notary zhorpp ...... and Io ~, o(~. pemon 1~3e~ ~o the accouniant to BUREAU OF ZNDZVTDUAL TAXES TNHERTTANCE TAX DZVTS/ON DEPT. 180601 HARR/SBURG, PA 17118-0601 COHMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-i$,~7 EX AFP (01-OS) EDWARD L SCHORPP ESQ HARTSON ETAL 10 E HIGH ST CARLISLE PA 17015 DATE ESTATE OF DATE OF DEATH FILE NUNBER COUNTY ACN 07-19-200q BLUMBERG 1Z-Zq-ZO03 21 0q-0011 CUMBERLAND 101 Amount Raa'ittad CLARENCE E HAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF WTLLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOT/CE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BLUMBERG CLARENCE E FILE NO. 21 0~-0011 ACN 101 DATE 07-19-200~ TAX RETURN NAS: (X} ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B} (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Hortgagas/Notas Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expansas/Adm. Costs/Misc. Expanses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. Total Deductions 12. Nat Value of Tax Return 51t000.00 .00 .0O .00 1/98q.03 118~219.83 69z8qO .35 (8) 26,~85.83 NOTE: To insure proper credit to your account, submit the upper port/on of ~his form with your tax payment. 15. 1~. NOTE: qa015.Z$ (1;) 210,5~$.15 Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5) Nat Value of Estate Subject to Tax (lq) Zf an assessment was issued previously, lines 1~, 15 and/or 16, 17, reflect figures that lnclude the total of ALL returns assessed to date. .00 210,5q3.15 ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rate 16. Aaount of L/ne lq taxable at Lineal/Class A rate 17. Amount of Line lq at Sibling rate 18. Amoun~ of Line 1~ ~axable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECETp1 DT$COUNT DATE NUHBER :]:NTEREST/PEN PA:]:D (- 03-18-200~ CD005696 ~75.68 18 and 19 will 9,q73.68 .76 (is) .00-x O0 _ .00 (17) ~-x = c_~ ~ . O0 (18) ~Q;:x ~:,~ ~:~i.i . oo AMOUNT P~::::~ 9 ,~:::~ 0 0 :~ ~:~'~ TOTAL TAX CREDIT BALANCE OF TAX DUE~ ZNTEREST AND PEN. I TOTAL DUE .00 .76 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR)~ YOU MAY GE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. RESERVATION: Estates of decedents dying on or before December 1Z, 1982 -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class D (coltaterat) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act Z3 of 2000o (7Z P.S. Section gl~O). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications ara available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z~-hour answering service for forms ordering: 1-800-$62-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-~qT-$OZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object ~ithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 767-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid aithin three (3) calendar months after the decadent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning Nith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January I, 198Z bear interest at the rata of six [BI) percent per annum calculated at a daily rata of .00016~. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate ~hich Hill vary from calendar year to calendar year ~ith that rate announced by the PA Department of Revenue. The applicable interest rates for IgBz through ZO0~ ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20Z .0005~8 ~'8-1991 ill .000301 ~ 9Z .OOOZ~7 1983 16Z .000~38 1992 9Z .0002~7 2002 6Z .00016~ 198~ 11~ .000501 199S-199~ 72 .00019Z ZOOS 52 .0001S7 1985 1SI .000356 1995-1998 9Z .O00Z~7 200~ ~Z .OOOllO 1986 102 .O0027~ 1999 72 .00019Z 1987 lOX .O00Z7q ZOO0 72 .00019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPA/D X NUNBER OF DAYS DELTNQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. Name of Decedent: REGISTER OF WILLS OF CUMBERLAND CO~¥ STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) CLARENCE E. BLUMBERG '04 SEP-8 Date of Death: File No.: December 24, 2003 2 !-04-00011 Social Security No.: 174-05-3746 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following.. ao Did the personal representative file a final account with the Court? Yes x No The separate Orphans' Court No. (if any)for the personal representative's account is: Did the personal representative state an account informally to the parties in interest? Yes ~ No Date: d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Courd and may be attached to this report. September ~, 2004 ~'ga;;tur~~~ : dward L. Schorpp, Es'~uire Address: MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Counsel for personal representative F:\F1 LES~DATAFILE\ESTATES\I 1071 - 1 .srep